Application for Admission - Wallace Community …

1 For Admission to Wallace Community college an applicant must provide one primary form of unexpired identification such as a driver s license, instruction permit, identification card, passport, or permanent resident card. To be admitted to Wallace Community college , applicants must submit the documentation identified above prior to registration for the first term of attendance. Which WCC Campus will you attend? Wallace Campus in Dothan Sparks Campus in Eufaula What term do you plan to enroll? Fall Spring Summer Year _____ Date of Birth ____/____/_____ Social Security Number ___ ___ ___ -- ___ ___ -- ___ ___ ___ ___ PLEASE PRINT CLEARLY Last Name First Name Middle List any other names by which transcripts may be listed Current Mailing Address City State Zip County (_____) _____-_____ (_____)

2 _____-_____ _____ Home Phone Cell Phone email State of Birth County of Birth Employer Employer s Phone Indicate your educational goal. Check boxes that apply in either area A or area B below. A. Planning to enroll in general studies courses at WCC for transfer purposes. (Check one) Associate in Science (AS) Associate in Arts (AA) Major:_____ _____ B. Planning to pursue a WCC AAS (non-transfer) degree or certificate program. (check one) Associate in Applied Science (AAS) Certificate (CER) Short Term Certificate (STC) Please choose one of the programs of study from page three: _____ Graduation Information Check One: High School Graduate Year of Graduation_____ GED Diploma Year of Diploma_____ _____ _____ Name of High School OR GED Test Center State Did either of your parents graduate with a 4-year degree?

3 Yes No Sex: Male Female (Optional) Ethnicity: Are you Hispanic or Latino? Yes No You may choose one or more of the race categories listed below: Black or African American Asian White American Indian or Alaska Native Hawaiian or Other Pacific Islander Citizenship: United States Citizen Resident Alien Foreign Visa Visa type :_____ Non-US Citizen: Deferred Action for Childhood Arrivals _____ Country of citizenship if other than Admissions Entry Status First-time college Student (have never attended college ) Transfer Student (List colleges on reverse side) Transient Student (List college on reverse side) Audit Student Please mark ALL that apply to your military status below: Using VA Benefits?

4 Yes No Active Duty Military Reserve/National Guard Military Dependent Veteran Name of person to notify in case of emergency: _____ Emergency Phone:_____ Office use only: Student #_____ Photo ID exp _____ Staff_____ Date_____ Application for Admission Wallace Campus in Dothan Sparks Campus in Eufaula 3. Non-Resident Request for In-State Tuition I live in one of the following counties with which Wallace Community college has a reciprocal agreement: Georgia: Baker Calhoun Chattahoochee Clay Stewart Decatur Dougherty Early Marion Terrell Seminole Miller Muscogee Quitman Randolph Sumter Webster Florida: Bay Calhoun Holmes Jackson Walton Washington I or my supporting person (spouse/parent(s)) is a member of the United States Military on full-time active duty stationed in Alabama under orders for duties other than attending school.

5 I or my supporting person (spouse/parent(s)) can verify full-time permanent employment in Alabama and commence said employment within 90 days of registration. I or my supporting person (spouse/parents) is a full-time permanent employee of Wallace Community college . I or my supporting person (spouse/parents) is an accredited member of a consular staff assigned to duties in Alabama. LIST ALL COLLEGES AND UNIVERSITIES PREVIOUSLY ATTENDED Have you earned a Degree or higher? Yes No Are you on suspension at another college /University? Yes No Colleges/Universities City/State Dates of Attendance Degree Earned Wallace Community college fully complies with the Family Educational Rights & Privacy Act of 1974, a federal law designed to limit the disclosure of personally identifiable information contained in education records.

6 Except for directory information as defined in the current college catalog, the personal information that you provide on this Application for Admission will not be disclosed to a third party without your express, written consent. If you would like to request non-release of directory information, please contact the Admissions and Records Office. CERTIFICATION OF ELIGIBILITY FOR IN-STATE TUITION Eligibility for in-state tuition is determined in one of three ways: LEGAL RESIDENCY, SUBSTANTIAL CONNECTIONS, or NON-RESIDENT REQUEST. Please provide information below in ONE category that qualifies you for in-state tuition. I. I certify that I am a resident of the State of Alabama: I (or my non-estranged spouse) have lived in the State of Alabama for at least 12 months immediately preceding my Application for Admission . I am a dependent student and my parent(s)/legal guardian(s) has/have lived in the State of Alabama for at least 12 months immediately preceding my Application for Admission .

7 I graduated from High School or obtained a GED in the State of Alabama within 3 years of the date of my Application for Admission . 2. I have more SUBSTANTIAL CONNECTIONS to the State of Alabama than any other state. (Check all that apply) I attended/graduated from an Alabama high school. I or my spouse/parent(s) have paid Alabama state income taxes as a resident. I or my spouse/parent(s) own a residence or other real estate in Alabama and have paid ad valorem taxes in the state on the residence or property. I am employed full time in the State of Alabama. I have previous periods of residency in the state continuing for one year or more. I am a registered voter and have voted in Alabama one year preceding my Application for Admission . I possess a state or local license(s) to do business or practice a profession in Alabama.

8 I own personal property in Alabama, paid Alabama taxes on the property, and possess Alabama license plates. I have maintained continuous physical presence in Alabama for a purpose other than attending school (excluding temporary absences for travel, military services, and temporary employment). I have membership in religious, professional, business, civic, or social organizations in Alabama. I have maintained checking accounts, savings accounts, safe deposit boxes, or investment accounts in Alabama. I have an in-state address shown on one or more of the following: Selective Service Registration Driver s License Automobile Title Registration Last Will and Testament Hunting/Fishing License Insurance Policies Stock/Bond Registrations Annuities or Retirement Plans I certify that the information contained in this Application is true and correct.

9 I understand any misstatement of facts may result in disapproval of this Application or expulsion from Wallace Community college . Signature Date Wallace Community college (WCC) is committed to equal opportunity education. The college is guided in philosophy and practice by the principle that individuals shall not be treated differently because of race, creed, religion, color, sex, age, national origin, or disability, and that legitimate and reasonable access to facilities shall be available to all. This principle particularly applies to the Admission of students in all programs of the college in their academic pursuits. It is also applicable in extracurricular activities, all student development services, employment of students by the college , and employment of faculty and non-instructional staff.

10 Therefore, WCC is in compliance with Title VI and VII of the Civil Rights Act of 1964, as amended; the Civil Rights Act of 1991: Executive Order 11246, as amended; Title IX of the Educational Amendments of 1972; Section 504 of the Rehabilitation Act; and the Americans with Disabilities Act of 1990. Wallace Community college is an Affirmative Action/Equal Employment and Educational opportunity Institution. If you require special accommodations under ADA, please let us know. Degrees and Certificates at Wallace Community college Please select a program of study and write it on page one of the Application for Admission . Wallace Campus in Dothan Associate in Applied Science degree (AAS) Air Conditioning/Refrigeration Applied Engineering Technology Advanced Manufacturing Tech Concentration Engineering Technology Concentration Industrial Systems Maintenance Concentration Nuclear Systems Maintenance Concentration Associate Degree Nursing (RN)